Palliative Care Consultations for Persons in the Medicare Skilled Nursing Facility (SNF) Setting

项目摘要/摘要 这份K23申请表描述了申请者Joan Gleba Carpenter博士的背景和经验， CRNP、ACHPN以及她计划获得实现其长期目标所需的知识和培训： 在开发和测试有效的养老院分娩方面成为独立的临床调查员 姑息治疗的典范。近三分之一的联邦医疗保险死者使用联邦医疗保险熟练护理设施 (SNF)在死亡前6个月内领取抚恤金。SNF护理通常会增加更具侵略性的风险，潜在地 繁重的治疗和未被识别或治疗不足的症状。姑息治疗可以减轻痛苦， 加强沟通，改善重病老年人的临终关怀和决策。 姑息治疗咨询(PCC)是一种潜在地改善老年患者护理的方法 SNF中的晚期疾病，但并不广泛使用。改善虚弱老年人的临终结局 并实现了独立，卡彭特博士在这一应用中制定了研究和培训计划。这个 具体的研究目的是：1)通过以下方式确定SNF-PCC干预的可行性和可接受性 确定：(A)符合资格标准的所有SNF患者的百分比；(B)符合条件的患者的百分比 谁同意参加；(C)接受SNF PCC的同意患者的百分比 收集数据；(D)临床医生对标准化SNF-PCC方案的忠诚度(定义为90%遵守 礼宾要素)，以及(E)代理人对咨询的满意度(可接受性)，定义为4和5 关于咨询满意度问卷(1-5分；得分越高表示满意度越高)；2) 估计SNF-PCC干预对患者/家庭照顾者报告的生活质量的影响程度 在80名患者中进行的先导性随机对照试验中，SNF-PCC术后7天和30天； 在SNF-PCC后7天和30天确定对SNF-PCC建议的遵守情况。具体的 将提供知识和技能以完成研究目标的培训目标是：1)扩展 理解和应用过渡护理原则，2)开发和量身定制临床干预措施， 3)掌握姑息治疗临床试验研究的技能，4)培训研究的伦理行为。这个 宾夕法尼亚大学的研究环境具有许多高质量、成熟的 这些资源将有助于卡彭特博士的发展。这项建议将为今后的工作奠定基础 测试姑息治疗干预措施的有效性和实施以加强护理的临床试验 以及患有严重疾病的老年人的结果。

Project Summary/Abstract This K23 application describes the background and experience of the applicant, Joan Gleba Carpenter, PhD, CRNP, ACHPN, and her plan to acquire the knowledge and training necessary to achieve her long-term goal: to become an independent clinical investigator in developing and testing effective nursing home delivery models of palliative care. Close to one-third of Medicare decedents use the Medicare skilled nursing facility (SNF) benefit in the 6 months prior to death. SNF care often increases the risk for more aggressive, potentially burdensome treatments and unrecognized or undertreated symptoms. Palliative care relieves suffering, enhances communication, and improves end-of-life care and decision making for seriously ill older adults. Palliative care consultation (PCC) is one approach that can potentially improve care for older adults with advanced illness in SNFs, but it is not widely available. To improve end of life outcomes for frail older adults and achieve independence, Dr. Carpenter has a developed a research and training plan in this application. The specific research aims are to: 1) Establish the feasibility and acceptability of the SNF-PCC intervention by determining: (a) percentage of all SNF patients who meet eligibility criteria; (b) percentage of eligible patients who consent to participate; (c) percentage of consented patients who receive the SNF PCC and from whom all data are collected; (d) clinician fidelity to the standardized SNF-PCC protocol (defined as 90% adherence to protocol elements), and (e) surrogate satisfaction with the consult (acceptability), defined as ratings of 4 and 5 on the Consultation Satisfaction Questionnaire (1-5 scale; higher scores reflect greater satisfaction); 2) Estimate the effect size of the SNF-PCC intervention on patient/family caregiver reported quality of life at seven days and 30 days post SNF-PCC in a pilot randomized controlled trial among 80 patients; and 3) Determine adherence to SNF-PCC recommendations at seven days and 30 days post SNF-PCC. The specific training objectives that will provide the knowledge and skills to complete the research aims are to: 1) expand understanding and application of the principles of transitional care, 2) develop and tailor clinical interventions, 3) acquire skills in palliative care clinical trials research, and 4) train in the ethical conduct of research. The research environment at the University of Pennsylvania features a number of high quality, well-established resources that will facilitate Dr. Carpenter's development. This proposal will provide the foundation for future clinical trials that test the effectiveness and implementation of palliative care interventions to enhance the care and outcomes for older adults with serious illness.